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mrcog part 1 > Revision notes 10: Pharmacology > Flashcards

Revision notes 10: Pharmacology Flashcards

1
Q

3 drugs that don’t cross placenta

A

Heparin
Insulin
Tubocurarine

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2
Q

Drugs that cause abortion

A

MET

Misoprostol
Ergotamine
Thrombolytic

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3
Q

Domperidone moa

A

dopamine antagonist

stimulates milk production

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4
Q

Drugs interfering with folate metabolism

A

Sulfonamide - inhibits conversion of benzoic acid to folate

Dihydrofolate reductase inhibitors

Trimethoprim
Methotrexate
Pyrimethamine

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5
Q

Aciclovir is an analogue of

A

guanine

it inhibits viral dna polymerase

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6
Q

Promethazine is an antagonist of what

A

H1 histamine antagonist

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7
Q

Ranitidine is an antagonist of what

A

H2 receptor antagonist

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8
Q

When are glucocorticoids given for fetal lung maturity

A

24h to 7 days before pre-term delivery

Up to 34+6 gestation
35+6 if SGA

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9
Q

finasteride mechanism of action

A

5a reductase inhibitor

prevents conversion of testosterone to dihydrotestosterone

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10
Q

Mifepristone

A

Binds to progesterone receptor but transcription inhibited

I.E anti-progestogenic

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11
Q

Mifepristone abortion rate on its own

A

60-80% effective

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12
Q

Contraindications to misoprostol

A 
Suspected ectopic pregnancy
Chronic adrenel insufficiency
Long-term corticosteroid therapy
Haemorrhagic disorders
Anti-coagulant therapy
Smokers over the age of 35 (avoid smoking / alcohol 2 days before and on the day of prostaglandin administration)
Hepatic / renal impairement
Avoid aspirin / NSAIDS for at least 8-12 days after mifepristone.
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13
Q

Ulipristal acetate (30 mg)

Contraceptive use?

A

Up to 5 days after intercourse

Selective progesterone receptor modulator

Once per cycle. If continuing with hormonal contraception, should use condoms until next period or withdrawal bleed

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14
Q

Absolute contraindications to COCP

A 
Smoker >15/day over 35 yrs old
<6 weeks post-partum
hypertension 160/100
History of VTE
IHD
CVA
Valvular heart disease
Migraine with focal neuro 
Current breast cancer
Diabetes with retinopathy
Cirrhosis
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15
Q

Clomiphene - when used

A

Non-steroidal antioestrogen with weak oestrogenic effects

Days 2-6 of cycle for ovulation induction

Used mainly in PCOS

Causes increase in GnRH, FSH, LH

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16
Q

Tamoxifen oestrogenic effects

A

Anti-oestrogen in breast

Anti-oestrogen on pre-menopausal uterus

Oestrogenic effects on post-menopausal uterus (inc risk endometrial carcinoma/hyperplasia

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17
Q

Bromocriptine & cabergoline & quinagolide

A

Dopamine agonists
Used to inhibit pituitary prolactin

Quinagolide - non-ergot pituitary selective dopamine-2 receptor agonist used when bromo dont work

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18
Q

PGE2 otherwise known as

A

Dinoprostone

Induction of labour

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19
Q

aspirin moa

A

IRREVERSIBLE inactivation of COX enzyme required for prostaglandin + thromboxane synthesis

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20
Q

furosemide site of action

A

ascending loop of henle

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21
Q

Aromatase inhibitors - two types

A

Irreversible - exemestane

Non-steroidal inhibitors - reversible
- Anastrozole, letrozole

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22
Q

Labetolol mechanism

A

Selective competitive alpha 1 adrenergic blocker
non-selective competitive beta adrenergic blocker
dose-related fall in BP without reflex tachy and without significant reduction in heart rate

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23
Q

Hydralazine moa

A

Vascular smooth muscle relaxation, decreased PVR
Causes reflex tachy + inc cardiac output

Can cause a syndrome similar to Lupus

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24
Q

idarucizumab is antidote for what

A

Dabigatran

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25
Q

Alkylating agent moa

A

Form covalent bonds with DNA side chains, causing depurination, strand breaks and cross-linking.

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26
Q

This drug decomposes within cells to form phosphoramine mustard and acrolein

A

Cyclophosphamide

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27
Q

Paclitaxel mechanism

A

Binds to micro-tubules to disrupt mitosis

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28
Q

First line treatment choriocarcinoma

A

methotrexate

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29
Q

methotrexate mechanism

A

inhibits dihydrofolate reductase

30
Q

azathioprine is converted to which active forms

A

6-mercaptopurine

6-thioinosinic acid

31
Q

This chemo drug binds to tubulin preventing polymerisation and disrupting mitosis

A

Vincristine/vinblastine

32
Q

warfarin works by

A

inhibiting vit k epoxide reductase (recycles oxidised vitk to its reduced form

33
Q

warfarin metabolism

A

hepatic microsomal mixed function oxidases

34
Q

Why is aspirin contraindicated in neonates and children

A

risk of rye syndrome

35
Q

MFO inducers

A 
Carbamazepine
Ethanol
Groseofulvin
Phenobarbitone
Phenytoin
Rifampicin

They INCREASE metabolism of glucocorticoids, contraceptives, theophylline, warfarin - need higher dose

36
Q

Inhibitors of hepatic enzymes

A

1) Phenelzine
2) Cimetidine
3) Isoniazide
4) Sodium valproate
5) Sulphonamides
6) Erythromycin
7) Theophylline

37
Q

safest ssri during pregnancy

A

fluoxetine

38
Q

SSRI taken after 20 weeks - risk of

A

persistent pulmonary hypertension

39
Q

when does the neural tube close?

A

day 28

40
Q

clozapine risk to fetus

A

agranulocytosis

41
Q

folic acid dose if on valproate

A

5mg/day

42
Q

lithium risks to fetus

A

increase risk of fetal heart defects: 60-1000 from 8-1000

Inc risk Ebstein’s anomaly - 1 in 20,000 to 10 in 20,000

43
Q

Lamotrigine in breast feeding women - significance

A

avoid

can cause Stevens-Johnson syndrome in the infant

44
Q

methotrexate - toxicity increased by:

A

antifolates e.g. trimethoprim, pyimethamine

sulphonamides

penicillin

probenecid

45
Q

Suxamethonium is a

A

nicotinic agonist

46
Q

tubocurarine, pancuronium, atracurium are examples of

A

competitive nicotinic antagonists

47
Q

Examples of muscarinic antagonists

A 
Atropine
Hyoscine
Ipratropium bromide
Imipramine
Quinidine

All competitive antagonists

48
Q

examples of competitive cholinesterase inhibitors

A

neostigmine

Physostigmine

49
Q

Doxazosin mechanism of action

A

alpha-adrenergic antagonist that inhibits a1 receptors

Anti-hypertensive
High affinity for alpha-1c adrenoceptor –> used in BPH

50
Q

benzo antagonist

A

flumazenil

51
Q

Anti-cholinergics for detrusor overactivity

A

oxybutynin, tolterodine

52
Q

mirabegron mechanism

A

b3-receptor agonist

Detrusor relaxation

Treat OAB

53
Q

First-line tocolytic

if contraindicated?

A

Nifedipine - calcium channel antagonist

Atosiban if contra (competitive oxytocin receptor antagonist)

54
Q

maximum contraction rate when using oxytocin for induction of labour

A

no more than 4-5 every 10 minutes

55
Q

Treatment of uterine hyperstimulation

A

terbutaline

56
Q

what is carboprost

A

PGF2a analogue (synthetic prostaglandin)

57
Q

what is misoprostol

A

synthetic prostaglandin E1 analogue

58
Q

misoprostol important side effects

A

Severe diarrhoea requiring withdrawal

associated with magnesium containing antacids

59
Q

medical treatment of stress urinary incontinence

A

duloxetine

60
Q

Why is nitrofurantoin avoided at term

A

risk of neonatal haemolysis

61
Q

plasma half life of oxytocin

A

1-6 minutes

62
Q

Following IV admin of oxytocin, effects subside within

A

1 hour

63
Q

embryopathic effect of warfarin occurs when

A

6-9 weeks

64
Q

firstline suppression of lactation

A

cabergoline

65
Q

properties of acidic drugs

A

higher oral bioavailability
poorer hepatic clearance
higher protein binding
smaller volumes of distribution

66
Q

anti-epileptic that increases risk of pcos

A

valproate

67
Q

uti drug in late pregnancy

A

trimethoprim

68
Q

indomethacin mechanism of action

A

cycloxygenase inhibitor

69
Q

molecular structure of heparin

A

polysaccharide

70
Q

main adrenergic receptor mediating detrusor relaxation

A

beta 3

71
Q

adrenergic receptors present in urinary bladder

A

beta 1, beta 2, beta 3

72
Q

Drug class that increases haematological toxicity of methotrexate

A

corticosteroids

mrcog part 1 (14 decks)

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